Effects of elevating the head of bed on interface pressure in volunteers

Peterson, Matthew J.; Schwab, Wilhelm K.; McCutcheon, Keir; Oostrom, Johannes H. van; Gravenstein, Nikolaus; Caruso, Lawrence J.

doi:10.1097/ccm.0b013e31818b8dbd

Cited by 63 publications

(61 citation statements)

References 22 publications

(13 reference statements)

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“…This finding, however, is consistent with the results of Peterson et al, 19 who also observed a significantly higher number of sensor cells reading 32 mm Hg or greater at the 45° semirecumbent position and higher angles.…”

Section: Discussionsupporting

confidence: 78%

“…This result differs from that of a recent investigation 19 in which peak pressures differed significantly between supine and 30° semirecumbent positions. Peterson et al 19 examined the effects of 7 different angles of backrest elevation on sacral interface pressures in healthy volunteers on a single bed used in an intensive care unit. Sacral peak pressures in the supine position were comparable to our findings, but peak pressures in the semirecumbent positions of 30° and 45° were higher.…”

Section: Discussioncontrasting

confidence: 56%

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Interface Pressure at Different Degrees of Backrest Elevation With Various Types of Pressure-Redistribution Surfaces

Lippoldt

Pernicka

Staudinger

2014

American Journal of Critical Care

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Background Increased elevation of the head of the bed is linked to a higher risk for sacral pressure ulcers. A semirecumbent position of at least 30° is recommended for the prevention of ventilator-associated pneumonia in patients treated with mechanical ventilation. Therefore, prevention of pressure ulcers and prevention of pneumonia seem to demand contradictory, possibly incompatible, positioning. Objectives To measure pressure at the interface between sacral skin and the supporting surface in healthy volunteers at different degrees of upright position with different types of mattresses. Methods An open, prospective, randomized crossover trial was conducted with 20 healthy volunteers. Interface pressure was measured by using a pressure mapping device with the participant in a supine position at 0, 10°, 30°, and 45° elevation and in the reverse Trendelenburg position at 10° and 30°. Four types of mattresses were examined: 2 different foam mattresses and 2 air suspension beds, 1 of the latter with low-air-loss technology. Results Peak sacral interface pressures increased significantly only at 45° of backrest elevation (P < .001). A mattress system with low-air-loss technology significantly reduced peak interface pressures at all angles (P < .001).The reverse Trendelenburg position led to lower peak pressures for all positions (P = .01). Conclusions Backrest elevation up to 30° might be a compromise between the seemingly incompatible demands of skin integrity and the prevention of ventilator-associated pneumonia. The reverse Trendelenburg position and a mattress system with low-air-loss technology could be additional useful tools to help prevent skin breakdown at the sacrum.

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Section: Discussionsupporting

confidence: 78%

Section: Discussioncontrasting

confidence: 56%

Interface Pressure at Different Degrees of Backrest Elevation With Various Types of Pressure-Redistribution Surfaces

Lippoldt

Pernicka

Staudinger

2014

American Journal of Critical Care

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“…Adopting a supine posture with the head of the bed elevated alters loading on the buttocks, which is why it is a controversial posture. Elevating only the head of the bed increases both the normal and frictional forces on the sacrum [38][39]. Mechanics suggests that as the head elevates, more of the upper-body weight will be transmitted through the buttocks to the supporting surface.…”

Section: Positioning Devices and Posturementioning

confidence: 99%

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

Sprigle¹,

Sonenblum²

2011

JRRD

102

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Abstract-The formation and underlying causes of p ressure ulcers (PUs) are quite complex, with multiple influencing factors. However, by definition pressure ulcers cannot form without loading, or pressure, on tissue. Clinical interventions typically target the magnitude and/or duration of loading. Pressure magnitude is managed by the selection of support surfaces and postural supports as well as body posture on supporting surfaces. Duration is addressed via turning and weight shifting frequency as well as with th e use of dynamic s urfaces that actively redistribute pressure on the body surfaces. This article shows that preventative interventions must be targeted to both magnitude and duration and addresses the rationale behind several common clinical interventions-some with more scientific evidence than others.

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“…19,20 Guidelines for preventing pressure ulcers recommend HOB elevation of 30º or less. 21,22 Based on these conflicting guidelines and difficulty maintaining higher HOB elevations, a study was needed to compare the outcomes of reflux, aspiration, and pressure ulcers simultaneously.…”

mentioning

confidence: 99%

Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study

Schallom¹,

Dykeman²,

Metheny³

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the risks and benefits of head-of-bed elevation. 2. Identify the findings at 30° and 45° head-ofbed elevation. 3. Discuss the early outcomes regarding head-ofbed elevation. Background Guidelines recommending head of bed (HOB) elevation greater than 30º to prevent ventilator-associated pneumonia conflict with guidelines to prevent pressure ulcers, which recommend HOB elevation less than 30º. Objectives To examine the feasibility of 45º HOB elevation and describe and compare the occurrence of reflux, aspiration, and pressure ulcer development at 30º and 45º HOB elevation. Methods A randomized 2-day crossover trial was conducted. HOB angle was measured every 30 seconds. Oral and tracheal secretions were analyzed for pepsin presence. Skin was assessed for pressure ulcers. Wilcoxon signed rank tests and

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Effects of elevating the head of bed on interface pressure in volunteers

Cited by 63 publications

References 22 publications

Interface Pressure at Different Degrees of Backrest Elevation With Various Types of Pressure-Redistribution Surfaces

Interface Pressure at Different Degrees of Backrest Elevation With Various Types of Pressure-Redistribution Surfaces

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study

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